Dobai Bernadett Miriam, Polgár Balázs, Gémesi Márk, Bogdan Manuella, Vigh Nikolett, Turáni Mirjam, Duray Gábor Zoltán, Bógyi Péter
Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania.
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary.
J Clin Med. 2025 Oct 31;14(21):7745. doi: 10.3390/jcm14217745.
: Pacemaker-induced cardiomyopathy (PICM) develops in up to 30% of patients with chronic right ventricular pacing. While biventricular (BIV) upgrade is the conventional strategy, conduction system pacing (CSP) offers a physiologic alternative recently endorsed by the 2025 ESC/EHRA Consensus Statement. However, comparative evidence in PICM is limited. Therefore, we aimed to compare outcomes of PICM patients undergoing CSP versus BIV upgrade. : This retrospective analysis included consecutive PICM patients who were upgraded to CSP or BIV between 2022 and 2024 at a single, experienced center. Follow-up averaged >19 months. Clinical outcomes, lead performance, echocardiographic parameters, complications, and quality of life (QoL) were evaluated. : Sixty-three patients were included (CSP: 26; BIV: 37). Mean age and sex distribution were similar; both groups had wide paced QRS complexes and a high ventricular pacing burden. Baseline left ventricular ejection fraction (LVEF) was lower in BIV patients (29 ± 7% vs. 35 ± 6%, = 0.01). Procedure duration was comparable, but fluoroscopy was shorter with CSP. QRS duration narrowed significantly in both groups (CSP: 163 ± 28→132 ± 12 ms; BIV: 171 ± 23→140 ± 18 ms; both < 0.05). During follow-up, LVEF improved (CSP: 41 ± 8%; = 0.008; BIV: 39 ± 8%, = 0.0001), as did NYHA class, with no significant intergroup differences. The rates of heart failure hospitalization, all-cause mortality, and QoL were similar. Notably, 34.6% of CSP patients retained their existing generator, suggesting procedural and economic benefits. : CSP is a feasible and potentially cost-efficient alternative to BIV upgrade in PICM, with comparable improvements in ventricular function, symptoms, and clinical outcomes. Larger prospective trials are warranted.
在高达30%的慢性右心室起搏患者中会发生起搏器诱导的心肌病（PICM）。虽然双心室（BIV）升级是传统策略，但传导系统起搏（CSP）提供了一种生理学替代方案，最近得到了2025年欧洲心脏病学会/欧洲心律协会共识声明的认可。然而，PICM方面的比较证据有限。因此，我们旨在比较接受CSP与BIV升级的PICM患者的结局。
这项回顾性分析纳入了2022年至2024年期间在一个经验丰富的单一中心升级为CSP或BIV的连续性PICM患者。随访平均超过19个月。评估了临床结局、导线性能、超声心动图参数、并发症和生活质量（QoL）。
纳入了63例患者（CSP组：26例；BIV组：37例）。平均年龄和性别分布相似；两组的起搏QRS波群均较宽，心室起搏负担较高。BIV患者的基线左心室射血分数（LVEF）较低（29±7%对35±6%，P = 0.01）。手术时间相当，但CSP组的透视时间较短。两组的QRS时限均显著变窄（CSP组：163±28→132±12毫秒；BIV组：171±23→140±18毫秒；均P<0.05）。在随访期间，LVEF有所改善（CSP组：41±8%，P = 0.008；BIV组：39±8%，P = 0.0001），纽约心脏协会（NYHA）心功能分级也有所改善，组间无显著差异。心力衰竭住院率、全因死亡率和QoL相似。值得注意的是，34.6%的CSP患者保留了现有的发生器，提示了手术和经济方面的益处。
在PICM中，CSP是BIV升级的一种可行且可能具有成本效益的替代方案，在心室功能、症状和临床结局方面有类似的改善。有必要进行更大规模的前瞻性试验。
